Healthcare Provider Details

I. General information

NPI: 1538527288
Provider Name (Legal Business Name): MICHELE VACARINO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6196 OAK BLUFF WAY
LAKE WORTH FL
33467-7136
US

IV. Provider business mailing address

6196 OAK BLUFF WAY
LAKE WORTH FL
33467-7136
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-8179
  • Fax:
Mailing address:
  • Phone: 561-676-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: